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Artropods and Human Disease 22 page

“What’s the news of the typhoid patients?” O’Donnell asked. “And the four suspected cases?”

“You can make it four definite now,” Chandler said, “and scratch two of the suspects.”

“Anyone in danger?”

“I don’t think so. Thank God for antibiotics! Fifteen years ago we’d have been in a lot more trouble than we are.”

“Yes, I suppose so.” O’Donnell knew better than to inquire about isolation procedure. For all his pompousness Chandler could always be relied on to do the correct thing medically.

“Two of the patients are nurses,” Chandler said. “One’s from Psychiatry, the other from Urology. The other two are men—a generator-room worker and a clerk from the records office.”

“All from widely separated parts of the hospital,” O’Donnell said thoughtfully.

“Exactly! There’s no common denominator except hospital food. All four took their meals in the hospital cafeteria. I don’t think there’s any question that we’re on the right track.”

“Then I won’t hold you up,” O’Donnell said. “You’ve two more people waiting outside, but some of the other men have more, and we’re shifting them around.”

“Very well,” Chandler said. “I’ll just keep going until we’re clear; nothing must stop us—no matter how long it takes.” He sat in his chair a little straighter. He had the feeling that there was a touch of derring-do and a ring of Old Glory to his own forthright words.

“Right you are,” O’Donnell said. “I’ll leave you to it.”

A little piqued by the casual reaction, the chief of medicine said stiffly, “You might ask the nurse to send in the next one, will you?”

“Sure.”

O’Donnell went out, and a moment later a girl kitchen worker entered. She was holding a card.

Chandler said, “I’ll take that. Sit down, please.” He put the card in front of him and selected a blank case-history sheet.

“Yes, sir,” the girl said.

“Now, first I want your medical history—yourself and your family—as far back as we can go. Let’s start with your parents.”

With the girl responding to his careful questioning, Chandler’s rapidly written notes began to fill the sheet in front of him. As always, when he was finished the result would be a model of good case-history reporting, suitable for inclusion in any medical textbook. One of the reasons Dr. Chandler was chief of medicine at Three Counties was because he was an extremely precise and conscientious clinician.

 

 

Walking away from the commandeered outpatients’ department, Kent O’Donnell permitted himself to think, for the first time with any degree of perspective, of some of the day’s events so far. It was now midafternoon, and since this morning so much had happened that it had been impossible to grasp the implications of it all.

In swift and unexpected succession had come, first, the incident of the mis-diagnosed child and, shortly afterward, its death. Then there had followed: Pearson’s firing, Charlie Dornberger’s retirement, the discovery that an elementary hygiene precaution had been neglected in the hospital for more than six months, and now the occurrence of typhoid, with the threat of an even graver epidemic hanging over Three Counties like an avenging sword.



So much, it seemed, had broken loose at once. Why? How had it happened? Was it a sudden symptom of a malaise that, undetected until now, had gripped the hospital? Was there more to come perhaps? Was this the signal of a general disintegration soon to follow? Had they all been guilty of a sense of complacency—of which O’Donnell himself might be the instigator?

He thought: We were all sure, so sure, that this regime was better than the last. We worked to make it so. We believed we were creating and progressing, building a temple of healing, a place where good medicine would be learned and practiced. But have we failed—ignominiously and blindly—through the very goodness of our own intentions? Have we been stupid and unseeing—our eyes on the cloud tops, uplifted by the glister of ideals, yet ignoring the plain earthy warning of everyday events? What have we built here? O’Donnell searched his mind. Is it, in truth, a place of healing? Or have we raised, in folly, a whited sepulcher—an empty, antiseptic shrine?

Preoccupied, his thoughts burning and intense, O’Donnell had strode through the hospital instinctively, unconscious of his surroundings. Now he came to his office and went inside.

He crossed to the window and stood looking down at the hospital forecourt. As always, there was a movement of people, coming and going. He saw a man limping, a woman holding his arm; they passed beneath and out of sight. A car drew up; a man jumped out and helped a woman into it. A nurse appeared, handing the woman a baby. The doors slammed; the car moved on. A boy on crutches came into view; he moved quickly, swinging his body with the ease of practice. He was stopped by an old man in a raincoat; the old man seemed uncertain where to go. The boy pointed. They moved together toward the hospital doors.

O’Donnell thought: They come to us in supplication, holding faith. Are we worthy of it? Do our successes mitigate our failures? Can we, in time, by devotion atone for error? Shall we ever know?

More practically, he reasoned: After today there must be many changes. They must plug gaps—not only those already exposed, but others they would uncover by diligent searching. They must probe for weaknesses—among themselves and in the hospital fabric. There must be greater self-criticism, more self-examination. Let today, he thought, stand as a bright and shining beacon—a cross of sorrow, a signal for a new beginning.

There was much to do, a great deal of work ahead. They would begin with Pathology—the weak spot where tribulation had begun. After that there must be reorganization elsewhere—there were several departments which he suspected were in need of it. It was definite now that work on the new buildings would begin in the spring, and the two programs could merge together. O’Donnell began to plan, his brain functioning swiftly.

The telephone rang sharply.

The operator announced, “Dr. O’Donnell, long distance is calling.”

It was Denise. Her voice had the same soft huskiness that had attracted him before. When they had exchanged greetings she said, “Kent darling, I want you to come to New York this next weekend. I’ve invited some people for Friday night and I intend to show you off.”

He hesitated only a moment. Then he said, “I’m terribly sorry, Denise—I won’t be able to make it.”

“But you must come.” Her voice was insistent. “I’ve sent out the invitations and I can’t possibly cancel them.”

“I’m afraid you don’t understand.” He felt himself struggling awkwardly to find the right words. “We have an epidemic here. I have to stay until it’s cleared up, then for a while at least there’ll be other things that must be done.”

“But you said you’d come, dearest—whenever I called you.” There was the slightest hint of petulance. He found himself wishing he were with Denise. He was sure then that he could make her understand. Or could he?

He answered, “Unfortunately I didn’t know that this would happen.”

“But you’re in charge of the hospital. Surely, just for a day or two, you can make someone else responsible.” It was obvious that Denise had no intention of understanding.

He said quietly, “I’m afraid not.”

There was a silence at the other end of the line. Then Denise said lightly, “I did warn you, Kent—I’m a very possessive person.”

He started to say, “Denise dear, please—” then stopped.

“Is that really your final answer?” The voice on the phone was still soft, almost caressing.

“It has to be,” he said. “I’m sorry.” He added, “I’ll call you, Denise—just as soon as I can get away.”

“Yes,” she said, “do that, Kent. Good-by.”

“Good-by,” he answered, then thoughtfully replaced the phone.

 

 

It was midmorning—the second day of the typhoid outbreak.

As Dr. Pearson had predicted, while a few stool samples had reached the lab yesterday afternoon, the bulk had arrived within the past hour.

The samples, contained in small cardboard cups with lids, were set out in rows on the center table of the pathology lab. Each was identified as to source, and Pearson, seated on a wooden chair at one end of the table, was adding a lab serial number and preparing report sheets on which the culture results would be recorded later.

As Pearson completed the preliminary paper work, he passed each specimen behind him to where David Coleman and John Alexander, working side by side, were preparing the culture plates.

Bannister, alone at a side table, was handling other orders on the lab which McNeil—now enthroned in the pathology office—had decided could not be delayed.

The lab stank.

With the exception of David Coleman all in the room were smoking, Pearson sending forth great clouds of cigar smoke to combat the odor as lids were lifted from the stool-specimen cups. Earlier Pearson had silently offered Coleman a cigar and the younger pathologist had lighted it for a while. But he had found the cigar almost as unpleasant as the undiluted air and had allowed it to go out.

The youthful hospital messenger who was Bannister’s avowed enemy had derived great satisfaction from bringing the specimens in, and with each new batch he had a fresh line of banter to accompany it. On his first trip he had looked at Bannister and announced, “They certainly found the right place to send this stuff.” Later he had told Coleman, “Got six new flavors for you, Doctor.” Now, setting a series of cartons in front of Pearson, he had asked, “You like cream and sugar in yours, sir?” Pearson grunted and went on writing.

John Alexander was working methodically, his mind concentrated on the work in hand. With the same fluidity of movement which David Coleman had noted at their first meeting he reached for a specimen cup and removed the cardboard lid. He pulled a petri dish toward him and, using a crayon pencil, copied the number from the lid onto the dish. Now he took a small platinum loop fixed to the end of a wooden handle and sterilized it in a burner flame. Next he passed the loop through the stool specimen, transferring a small portion of it to a tube of sterile saline. He repeated the process, then, using the platinum loop again, planted some of the solution on the culture plate, moving the loop in even, steady strokes.

Now he labeled the saline tube and placed it in a rack. The petri dish, with its culture plate, he carried across the lab to an incubator. There it would remain until the following day when subcultures, if necessary, could be begun. The process was one which could not be hurried.

He turned away to find David Coleman close behind him. On impulse Alexander said quietly, conscious of Pearson across the room, “Doctor, there’s something I wanted to tell you.”

“What is it?” Coleman added a petri dish himself to the incubator and closed the door.

“I . . . that is, we . . . have decided to take your advice. I’m going to apply for medical school.”

“I’m glad.” Coleman spoke with genuine feeling. “I’m sure it will turn out well.”

“What will turn out well?” It was Pearson, his head lifted, watching.

Coleman went back to his work position, seated himself, and opened a new specimen. He said matter-of-factly, “John’s just told me he’s decided to apply for medical school. I advised him some time ago that he should.”

“Oh.” Pearson looked at Alexander sharply. He asked, “How will you afford it?”

“My wife can work, for one thing, Doctor. And then I thought I might get some lab work out of school hours; a lot of medical students do.” Alexander paused, then, glancing at Coleman, he added, “I don’t imagine it will be easy. But we think it will be worth it.”

“I see.” Pearson had blown out smoke; now he put down his cigar. He seemed about to say something else, then hesitated. Finally he asked, “How is your wife?”

Quietly Alexander answered, “She’ll be all right. Thank you.”

For a moment there was silence. Then Pearson said slowly, “I wish there was something I could say to you.” He paused. “But I don’t suppose words would do very much good.”

Alexander met the old man’s eyes. “No, Dr. Pearson,” he said, “I don’t believe they would.”

 

 

Alone in her hospital room, Vivian had been trying to read a novel which her mother had brought, but her mind would not register the words. She sighed and put the book down. At this moment she wished desperately that she had not forced Mike into promising to stay away. She wondered: should she send for him? Her eyes went to the telephone; if she called he would come, probably within minutes. Did it really matter—this silly idea of hers of a few days’ separation for them both to think things over? After all, they were in love; wasn’t that enough? Should she call? Her hand wavered. She was on the point of picking up the receiver when her sense of purpose won out. No! She would wait. This was already the second day. The other three would go quickly, then she would have Mike to herself—for good and all.

 

 

In the house-staff common room, off duty for half an hour, Mike Seddons lay back in one of the deep leather armchairs. He was doing exactly what Vivian had told him—thinking of what it would be like living with a wife who had only one leg.

 

 

Twenty-three

 

 

It was early afternoon. Four days had gone by since the initial cases of typhoid in Three Counties Hospital had been reported.

Now, in the administrator’s office, serious-faced and silent, Orden Brown, the board chairman, and Kent O’Donnell were listening to Harry Tomaselli speaking on the telephone.

“Yes,” the administrator said, “I understand.” There was a pause, then he continued, “If that becomes necessary we shall be ready with all arrangements. At five o’clock then. Good-by.” He replaced the phone.

“Well?” Orden Brown asked impatiently.

“The City Health Department is giving us until this evening,” Tomaselli said quietly. “If we’ve failed to locate the typhoid carrier by then we shall be required to close the kitchens.”

“But do they realize what that means?” O’Donnell had risen to his feet, his voice agitated. “Don’t they know it will practically have the same effect as closing the hospital. You’ve told them, haven’t you, that we can’t get outside catering for more than a handful of patients?”

Still quietly, Tomaselli said, “I’ve told them, but it doesn’t make any difference. The trouble is, the public-health people are afraid of an outbreak in the city.”

Orden Brown asked, “Is there any news at all from Pathology?”

“No.” O’Donnell shook his head. “They’re still working. I was in there half an hour ago.”

“I can’t understand it!” The board chairman was more disturbed than O’Donnell had ever seen him before. “Four days and ten typhoid cases right here in the hospital—four of them patients—and we still haven’t come up with the source!”

“There’s no question it’s a big job for the lab,” O’Donnell said, “and I’m sure they haven’t wasted any time.”

“No one’s blaming anyone,” Orden Brown snapped; “not at this stage anyway. But we’re got to show some results.”

“Joe Pearson told me they expect to be through with all their cultures by midmorning tomorrow. If the typhoid carrier is among the food handlers, they’ll have to have traced him by then.” O’Donnell appealed to Tomaselli. “Can’t you persuade the public-health people to hold off—at least until midday tomorrow?”

The administrator shook his head negatively. “I tried earlier. But they’ve given us four days already; they won’t wait any longer. The city health officer was here again this morning, and he’s returning at five o’clock. If there’s nothing to report by then I’m afraid we’ll have to accept their ruling.”

“And meanwhile,” Orden Brown asked, “what do you propose?”

“My department is already at work.” Harry Tomaselli’s voice held the sense of shock and unbelief that gripped them all. “We’re proceeding on the assumption that we shall have to close down.”

There was a silence, then the administrator asked, “Kent, could you come back here at five—to meet the health officer with me?”

“Yes,” O’Donnell said glumly. “I suppose I should be here.”

 

 

The tension in the lab was equaled only by the tiredness of the three men working there.

Dr. Joseph Pearson was haggard, his eye red-rimmed, and weariness written in the slowness of his movements. For the past four days and three nights he had remained at the hospital, snatching only a few hours of sleep on a cot which he had had moved into the pathology office. It was two days since he had shaved; his clothes were rumpled and his hair wild. Only for one period of several hours on the second day had he been missing from Pathology, with no one knowing where he had gone and Coleman unable to locate him despite several inquiries from the administrator and Kent O’Donnell. Subsequently Pearson had reappeared, offering no explanation for his absence, and had continued his supervision of the cultures and subcultures which occupied them still.

Now Pearson asked, “How many have we done?”

Dr. Coleman checked a list. “Eighty-nine,” he said. “That leaves another five in incubation which we’ll have tomorrow morning.”

David Coleman, though appearing fresher than the senior pathologist, and with none of the outward signs of personal neglect which Pearson exhibited, was conscious of an oppressive weariness which made him wonder if his own endurance would last as long as the older man’s. Unlike Pearson, Coleman had slept at his own apartment on each of the three nights, going there from the lab well after midnight and returning to the hospital around six the following morning.

Early as he had been, though, in arriving, only on one occasion had he preceded John Alexander, and then by a mere few minutes. The other times the young technologist had already been occupied at one of the lab benches, working—as he had since the beginning—like a precisely geared machine, his movements accurate and economic, his written record of each test stage painstakingly recorded in neat and legible lettering. Nor had it been necessary—after the initial start—to issue more instructions. Alexander was so obviously competent and aware of what he was doing that Dr. Pearson, after inspecting his progress briefly, had nodded approval and from that point had left him entirely alone.

Turning from Coleman to Alexander, Pearson asked now, “What are your figures on the subcultures?”

Reading from notes, Alexander answered, “Of the eighty-nine plates checked, forty-two have been separated for subculturing, and two hundred and eighty subcultures planted.”

Pearson calculated mentally. Half to himself he said, “That means another hundred and ten subcultures still to check, including tomorrow’s batch.”

Glancing across at John Alexander, David Coleman wondered what the younger man was feeling at this moment and whether the act of throwing himself so intensely into this endeavor was proving an outlet for at least some of his personal grief. It had been four days since the Alexander baby’s death. In that time the original sense of shock and desolation which the young technologist had shown had disappeared, at any rate superficially. Coleman suspected, though, that John Alexander’s emotions were still not far below the surface, and he had sensed something of their presence in Alexander’s announced intention to enroll in medical school. It was a subject which David Coleman had not pursued so far, but he had resolved, as soon as this present crisis was over, to have a long talk with Alexander. There was a good deal of advice and guidance which Coleman could offer the younger man, based on his own experiences. Certainly, as Alexander had said, it would not be easy for him—particularly financially—to give up a salaried job and become a student once more, but there were certain guideposts Coleman could point to and pitfalls which he might help Alexander to avoid.

The fourth member of the original lab team, Carl Bannister, was temporarily disqualified. The senior technician had worked through three days and most of the nights, handling routine lab work alone and assisting the others whenever he could. This morning, however, his speech had been slurred and he was so obviously near exhaustion that David Coleman, without consulting Pearson, had ordered him home. Bannister had departed gratefully and without argument.

The preparatory work on the stool samples arriving in the lab had gone on continuously. By the second day, however, those samples which had been dealt with first had been in incubation long enough for investigation. Once again Dr. Pearson had divided his forces in order to keep the work flowing, John Alexander and himself handling the new stage, while David Coleman continued to deal with the remaining stool samples still coining in.

Removed from the incubator, the pink-tinged surface of the prepared petri dishes showed small, moist bacteria colonies where the tiny amounts of human feces had been added the previous day. With every individual stool containing millions of bacteria, the next task was to separate those colonies which were obviously harmless from those which must be investigated further.

Pink-tinged colonies of bacteria were eliminated at once as harboring no typhoid. Pale colonies, where typhoid bacilli might conceivably lurk, had samples taken from them for subculture in sugar tubes with liquid media. There were ten sugar tubes to each original culture, each tube containing a different reagent. It was these reagents which, after further incubation, would finally show which stool sample, if any, contained the marauding and infectious typhoid germs.

Now, on the fourth day, all the stool samples were finally in. They had been obtained from everyone on the hospital staff involved in any way with the receiving, preparation, or distribution of food, and the task of processing them would continue until well into tomorrow. At the moment the 280 subcultures which John Alexander had referred to were distributed in racks around the lab and in incubators. But although on many of these the final checks were complete, none so far had revealed the individual—the suspected typhoid carrier—whom, anxiously and diligently, they had been seeking day and night.

The telephone bell rang and Pearson, nearest to the lab wall phone, answered it. “Yes?” He listened, then said, “No; nothing yet. I keep telling you—I’ll call as soon as we find anything.” He replaced the instrument.

John Alexander, succumbing to a sudden tiredness, completed an entry on a data sheet, then dropped into a straight-back lab chair. Momentarily he closed his eyes with relief at his own sudden inactivity.

From alongside David Coleman said, “Why don’t you take an hour or two off, John—maybe go upstairs and stay with your wife for a while?”

Alexander got to his feet again. He knew that if he remained seated too long he could easily fall asleep. “I’ll do one more series,” he said, “then I think I will.”

Taking a rack of subcultures from the incubator, he collected a fresh data sheet and began to line up the ten sugar tubes he was about to check. Glancing at the lab wall clock, he noted with surprise that another day was running out. The time was ten minutes to five.

 

 

Kent O’Donnell replaced the telephone. Answering Harry Tomaselli’s unspoken question, he said, “Joe Pearson says there’s nothing new.”

In the administrator’s birch-paneled office there was a silence, both men bleakly aware of the implications of this latest lack of news. Both knew, too, that around them, outside the administration suite, the work of the hospital was grinding to a halt.

Since early afternoon the plan for contraction of patient service, devised by Harry Tomaselli several days earlier and now made necessary by the impending shutdown of the hospital kitchens, had been going steadily into effect. Commencing with breakfast tomorrow, one hundred meals for patients on regular diet would be prepared by two local restaurants, combining forces for the occasion, and would be delivered to the hospital for seriously ill patients who could not be moved. Of the remaining patients, as many as possible were being discharged to their homes, while others, for whom hospital care was still essential, were being transferred to other institutions in and around Burlington, now mobilizing their own facilities to meet the emergency influx from Three Counties.

An hour ago, knowing that the process of transfer would have to continue far into the night, Harry Tomaselli had given the order for evacuation to begin. Now a line of ambulances, summoned by telephone from all available points, had begun to assemble outside the emergency entrance. Meanwhile, in the wards and private pavilion, nurses and doctors were working briskly, moving patients from beds to stretchers and wheel chairs in readiness for their unexpected journey. For those with time for thinking it was a sad and somber moment. For the first time in its forty-year history Three Counties Hospital was turning the sick and the injured away from its doors.

There was a light tap, and Orden Brown entered the administrator’s office. He listened attentively while Harry Tomaselli reported what had been done since their meeting four hours earlier. At the end the board chairman asked, “The city health authorities—have they been here again?”

“Not yet,” Tomaselli answered. “We’re expecting them now.”

Orden Brown said quietly, “Then if you don’t mind, I’ll wait with you.”

After a pause the board chairman turned to O’Donnell. “Kent, this isn’t important now, but I’ll tell you while I think of it. I’ve had a call from Eustace Swayne. When all this is over he would like you to go and see him.”

For an instant the effrontery of the request left O’Donnell speechless. It was obvious why Eustace Swayne wanted to talk with him; there could be only one reason—despite everything the old man intended to use his money and influence in an attempt to intercede for his friend, Dr. Joseph Pearson. After all that had happened over the past few days it seemed unbelievable that such blindness and presumption could exist. A boiling fury seethed within O’Donnell. He said explosively, “To hell with Eustace Swayne and all his works!”

“May I remind you,” Orden Brown said icily, “that you happen to be speaking of a member of the hospital board. Whatever your disagreements, he at least is entitled to be treated with courtesy.”

O’Donnell faced Orden Brown, his eyes blazing. Very well, he thought, if this is the showdown, then let’s have it. I’ve finished with hospital politics—for good and as of now.

At the same moment a buzzer sounded on the administrator’s desk. “Mr. Tomaselli,” a girl’s voice said on the intercom, “the public-health officers have just arrived.”

It was three minutes to five.

 

 

As they had on a morning six weeks earlier—the day on which, as he realized now, Kent O’Donnell had received his first warning of impending disruption in the hospital—the chimes of the Church of the Redeemer announced the hour as the small group threaded its way through the corridors of Three Counties. Led by O’Donnell, it included Orden Brown, Harry Tomaselli, and Dr. Norbert Ford, city health officer of Burlington. Behind them were Mrs. Straughan, the chief dietitian, who had arrived at the administration suite as they were leaving, and a young assistant health officer whose name O’Donnell had missed in the flurry of introductions.

Now that his initial anger was over, the chief of surgery was relieved that the interruption of a few minutes ago had prevented what could have become a major quarrel between himself and Orden Brown. He realized that all of them, himself included, had become unnaturally tense over the past few days, and the board chairman had, after all, done no more than relay a message. O’Donnell’s real quarrel was with Eustace Swayne, and he had already resolved to meet the old tycoon face to face as soon as this present business was over. Then, whatever overtures Swayne chose to make, O’Donnell planned to respond with plain, blunt words, no matter what the consequences might be.

It had been Kent O’Donnell’s suggestion that the group should visit the pathology department. He had told the city health officer, “At least you’ll see we’re doing everything possible to trace the source of infection.”

Dr. Ford had at first demurred. “There’s been no suggestion that you’re not, and I doubt if I could add anything to what your pathologists are doing,” he had said. But at O’Donnell’s insistence he had agreed to go, and now they were en route to the basement pathology lab.

John Alexander glanced up as the group entered, then continued with the sugar test he was carrying out. Pearson, on seeing O’Donnell and Orden Brown, moved forward to meet them, wiping both hands on his already soiled lab coat. At a signal from Harry Tomaselli, David Coleman followed him.


Date: 2014-12-21; view: 659


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